| NPI | 1265696173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN LORENZO MADDATU Dentist 818-786-8803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55562) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2009-10-22 |